What is a migraine?
A migraine is a neurological condition that causes an intense headache, usually on one side of the head, lasting anywhere from a few hours to several days. Many people experience other symptoms accompanying the headache, such as nausea, vomiting, and sensitivity to light and sound. Approximately 12% of Americans experience migraine headaches, with women being three times more likely than men to get migraines. There is no cure for migraines; however, there are treatments that may help reduce pain and other symptoms or prevent migraines from occurring. Researchers are also continuing to study novel treatment methods; for example, various clinical trials have been conducted on the use of a smartphone app and neurostimulation at home to relieve pain.
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People who experience migraines may seek medical advice from their family doctor or receive a referral to a neurologist for the treatment of migraines. During the diagnostic process, healthcare providers ask about family history, symptoms, and the frequency of symptoms. During an initial assessment, a healthcare provider may ask questions about your migraine symptoms and health history, such as:
- How often do you have headaches?
- Where is the pain located?
- How long do headaches last?
- Do headaches coincide with your menstrual cycle?
- What other symptoms do you have with the headache?
- Do you know of any family members with migraines?
- What treatments have you used, including over-the-counter medications, and how did they work?
Around 25% of people with migraines also have a symptom before the onset of the headache called an aura. An aura can develop over a period of minutes, last up to an hour, and may cause symptoms such as:
- Visual disturbance, such as seeing bright spots or flashes of light
- Vision loss
- Tingling sensation in arms or legs
- Feelings of weakness or numbness on one side of the face
Once the migraine is gone, people often feel exhausted and disoriented or as if they are in a fog for a few hours to a couple of days. Discussing auras or feeling drained as migraine symptoms with a doctor or healthcare provider is important. There isn’t a medical test to diagnose migraines. However, your doctor might request a blood test, MRI, or CAT scan to rule out other causes of headaches before making a definitive diagnosis.
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Migraine treatment options
There is currently no cure for migraines. Instead, treatment may help reduce the intensity of symptoms, relieve severe pain or discomfort during a migraine attack, decrease the frequency of headaches, or prevent recurrent episodes. You should seek medical advice about medications if your headaches interfere with your ability to carry out daily activities. There are two main types of medications for migraines:
- Abortive treatment works to reduce or eliminate an acute migraine headache once it starts. These treatments work best if taken at the first sign of a headache. There are both over-the-counter and prescription medications available for pain relief.
- Preventive treatment, also called prophylactic treatment, is taken daily, even when you don’t have a headache. Preventive medications, which reduce the frequency of headaches, are only available through a prescription; however, some lifestyle changes may help reduce symptoms or the frequency of headaches.
Migraine medications
There are three main types or classes of drugs for the abortive type of medications: NSAIDs, triptans, and ergot alkaloids. These medications are most effective when taken as early as possible to the start of a headache.
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over the counter or in stronger doses as a prescription. They can be effective at relieving mild to moderate migraine pain or discomfort. Certain medications contain a combination of acetaminophen, aspirin, and caffeine, which may effectively treat mild-to-moderate migraine symptoms. Common NSAID pain relievers include:
- Advil, Motrin (ibuprofen)
- Aleve (naproxen)
- Aspirin (acetylsalicylic acid)
- Excedrin Migraine (acetaminophen, aspirin, and caffeine)
- Indocin (indomethacin)
- Toradol (ketorolac)
Triptans
Triptans act on serotonin receptors, which can help narrow the brain's blood vessels and decrease pain signals. Triptans are prescription drugs available as regular oral tablets, orally disintegrating tablets, nasal sprays, or small injections under the skin. Triptan medicines should not be used by those with high blood pressure or heart disease. Examples of triptans include:
Ergot alkaloids
Ergot alkaloids can be used to treat severe migraine headaches and cluster headaches. They work by constricting blood vessels and reducing inflammation, which may lessen the pain from a migraine. This headache medication can be combined with caffeine, which helps the medicine be absorbed more quickly, thereby providing faster relief. Ergot alkaloids may also reduce nausea and help with relaxation, making it easier to fall asleep. They should not be used by those with high blood pressure or heart disease. Examples of ergot alkaloids include:
- Ergomar (Ergotamine Tartrate)
- Migranal (Dihydroergotamine Mesylate)
- D.H.E. 45 (Dihydroergotamine Mesylate)
- Cafergot (Ergotamine Tartrate and Caffeine)
- Migergot (Ergotamine Tartrate and Caffeine)
Migraine prevention
Some medications are used to prevent migraine headaches. These medications are generally available with a prescription only. When used appropriately, they may help reduce the frequency of migraine headaches. These medications are taken daily, even when you do not have a headache. Many were designed to treat other conditions, such as epilepsy and depression, but were also found to reduce headaches. The FDA approved three preventive drugs developed specifically for migraines in 2019. Other medications that have been found helpful in preventing migraines include antidepressants, anticonvulsants, and beta blockers.
CGRP antagonists
Three drugs developed specifically for preventing migraines were approved by the FDA in 2019—Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab). These medicines target a protein called CGRP (calcitonin gene-related peptide) in the brain. The CGRP protein can cause inflammation, which is thought to play a part in triggering migraines. By blocking this protein, these drugs may help prevent migraines. Compared to older migraine medicines, these CGRP antagonists are processed differently in the body and usually have fewer side effects.CGRP antagonists are self-injected using a device with a small needle that automatically injects the medicine just under the skin. A benefit of these medications is they only need to be injected monthly or quarterly, depending on the drug. For example, Aimovig and Emgality are administered as a once-monthly subcutaneous injection, while Ajovy can be administered monthly or quarterly.
Antidepressants
In some cases, antidepressants may be prescribed off-label to prevent migraines. Some commonly used antidepressants that may help prevent migraines include:
Anticonvulsants
Only two anticonvulsants are approved for migraine prevention:
Beta blockers
Beta blockers are typically used for heart conditions, such as high blood pressure, and can help reduce the frequency of migraines. These medications include:
Injectables
Botox shots may also help prevent migraine headaches. Botox is available as a prescription drug for people with chronic migraines, which is classified as a migraine on 15 or more days each month with headaches lasting four or more hours each. Botox contains botulinum toxin, which is injected into the muscles around the forehead, temples, and neck, among other areas, to help prevent migraines.
What is the best medication for migraines?
There is no “best” migraine medicine. People react differently to medications, and what is the best medication for one person may not be the right one for someone else. Choosing the best medication for each person depends on several factors, including:
- Other medical conditions a person has
- Other medications currently being used and potential drug interactions
- Potential side effects of a medication
- Response to treatment
- The goal of treatment (acute or preventive)
Some people may need to try different medications and dosages before finding the right treatment. A healthcare provider will help determine the most appropriate dosage based on a person’s overall condition. The following is a comparison chart to help you understand the most commonly prescribed medications for migraine.
Best medications for migraines
Dosage should be determined only by a doctor or healthcare provider based on a patient’s medical condition, response to treatment, age, weight, etc. Other adverse effects may occur, as this is not a complete list.
What are the common side effects of migraine medication?
The following is a list of some common side effects of migraine medications. Before taking any medication, talk to a healthcare professional about all the possible side effects of your medication. Triptans
- Dizziness
- Dry mouth
- Nausea
- Tingling, numbness, or flushing of the skin
- Sleepiness
- Fatigue
- Tight feeling in chest, throat, or jaw
Ergot alkaloids
- Nausea
- Vomiting
- Numbness or tingling
- Weakness
- Dizziness
Antidepressants
- Nausea
- Insomnia
- Restlessness
- Dizziness
- Drowsiness
- Dry mouth
- Weakness
- Sexual dysfunction
Anticonvulsants
- Dizziness
- Drowsiness
- Headache
- Diarrhea
- Upset stomach
- Weight changes
- Hair loss
- Tremor
- Rash
CGRP antagonists
- Nausea
- Shortness of breath
- Injection site reactions
- Drowsiness
Beta blockers
- Fatigue
- Weakness
- Dizziness
- Slow heartbeat
- Nausea
- Dry mouth
- Sleep changes
What are non-drug remedies for migraines?
Understanding migraine triggers
While triggers can differ for each individual, several common triggers exist. Tracking your migraines to understand your triggers better may help you to avoid or limit the triggers and reduce the number of headaches you experience. A study of 1,200 migraine patients found that around 76% had triggers. Common triggers may include stress, hormones, certain types of weather, perfume or certain smells, neck pain, light(s), alcohol, smoke, sleeping late, heat, food, exercise, and sexual activity.Migraine headaches can also be triggered by medication overuse. Therefore, it’s important to pay attention to the directions on your medications and seek medical advice if you are experiencing headaches often.
Lifestyle changes
Some lifestyle changes might help to reduce the frequency or intensity of migraine headaches. These include:
- Understanding, avoiding, and limiting exposure to triggers
- Keeping a routine, such as waking up and going to bed at the same time each day
- Eating healthy meals
- Not skipping meals
- Exercising regularly
- Limiting alcohol and caffeine
- Practicing stress management techniques, such as deep breathing exercises or meditation
- Practicing yoga, as research shows that regular yoga sessions alongside conventional treatments may reduce the frequency and severity of migraines
Home remedies for migraines
While home remedies do not usually prevent or reduce the frequency of headaches, there are things you can do to manage symptoms when you do have a migraine:
- Use ice packs or cool compresses on your forehead, scalp, or neck
- Use over-the-counter pain medications like NSAIDs
- Have some caffeine—although caffeine is listed among the potential triggers of migraines, it may provide some relief during a migraine episode when used in moderation.
- Minimize light and sound in your environment by lying down in a dark, quiet room
Supplements and vitamins for migraines
There are a few vitamins and supplements that may help to reduce the frequency and intensity of migraines:
- Magnesium – Magnesium is found in dark green veggies, whole grains, and nuts. It will not help once you have a headache, but there is evidence that some migraine sufferers have a magnesium deficiency. One small study found that 41% of participants felt significant relief with daily magnesium supplements.
- Vitamin B2 (riboflavin) – Riboflavin is found in milk, cheese, fish, and chicken. A few studies have found that this vitamin may help decrease the frequency of migraine attacks.
- Feverfew - Feverfew is a plant native to western Asia and the Balkans. It may help prevent migraines and reduce symptoms. Side effects include digestive problems like nausea and bloating.
- Butterbur – Butterbur is a plant that grows in Europe, Asia, and North America. There is evidence that butterbur may be beneficial in preventing migraines. However, butterbur is not typically recommended due to the risk of liver toxicity.
Finding the right migraine treatment
Finding the right migraine treatment can greatly improve the quality of life of someone who experiences migraines. However, finding the right treatment starts with an accurate diagnosis. For example, a healthcare provider may evaluate the severity of your symptoms, other medications you take, and your overall condition. The right treatment will also depend on your goals for treatment. What works for one person might not work for another, and it may take some trial and error to find the most effective treatment for you. Your healthcare provider can guide you in creating a treatment plan that suits your needs. This plan may include a combination of medicines, such as FDA-approved acute treatments for when migraines occur or preventive medications to reduce the frequency of migraines. In some cases, other options, such as transcranial magnetic stimulation, cognitive behavioral therapy, or botulinum toxin injections, may benefit some individuals.
It’s important to discuss potential treatment options with your healthcare provider. You should follow the treatment plan as prescribed to ensure the treatment is safe and effective.
Frequently asked questions about migraines
What is the best treatment for a migraine?
The most effective treatment for a migraine will depend on the individual and the severity of their symptoms. Certain medications, such as CGRP antagonists and beta blockers, may be recommended to prevent migraine. On the other hand, triptans, NSAIDs, and ergot alkaloids may be more effective for the acute treatment of migraines.
What are the types of migraines?
There are several different types of migraines that can vary in how they feel and what triggers them. A migraine without aura, often called a common migraine, is a severe headache with nausea without any visual or sensory changes. A migraine with aura, or classic migraine, on the other hand, includes warning signs like visual disturbances before the headache begins. Chronic migraines are characterized by headaches occurring 15 or more days per month for over three months. An episodic migraine happens less frequently. Other types of migraines may include but are not limited to:
What are the newest drugs for migraines?
The newest drugs for migraines include Aimovig, Ajovy, and Emgality. These medications belong to a class of drugs called CGRP antagonists, which work by blocking the effects of the substance CGRP that may play a role in triggering a migraine attack. CGRP antagonists work differently from other migraine medications and generally have fewer side effects. These are the first preventive medications created specifically for migraines.
How do you make migraines go away?
The best way to make migraines go away is to start treating them at the first sign of a headache. You can try over-the-counter pain medications, prescription medications, or home remedies, such as using an ice pack, lying in a cool, dark room, or removing yourself from stressful situations.
Do painkillers cure migraines or just stop us from feeling it?
Painkillers, like other medicines, don't cure migraines but may help manage headache pain and other symptoms. They work by blocking pain signals, so you don’t feel the effects of the migraine as much. Taking a painkiller can make a significant difference for many people and allow them to go about their daily activities. Still, painkillers may cause side effects, depending on the medication. It’s important to consult a healthcare provider for more information on the most appropriate option for you.
Can you die from a migraine headache?
Migraines can disrupt a person’s ability to perform daily activities. However, they are not usually life-threatening. For some people with migraines, especially those who get migraines with auras, there may be an increased risk of stroke or heart attack. People who experience migraines with aura may want to attend regular screenings for heart disease and take proactive steps, such as eating right, exercising, and living a healthy lifestyle. Which migraine medications are safe to use during pregnancy or while breastfeeding?
Many migraine medications are unsafe to take if you are pregnant or breastfeeding due to the risk of birth defects and other problems. Some medications may cause harm to an unborn baby or pass through breast milk and harm a breastfeeding child. Certain migraine medications, such as triptans and NSAIDs, are not generally recommended during pregnancy. Instead, Tylenol (acetaminophen) may be a safe option when taken appropriately. It’s important to consult a healthcare provider for migraine treatment options while pregnant or breastfeeding.
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